Rheumatology International (2024) 44:1501–1508

https://doi.org/10.1007/s00296-024-05638-w

OBSERVATIONAL RESEARCH

Knowledge, perceptions, and practices of axial spondyloarthritis

diagnosis and management among healthcare professionals: an
online cross-sectional survey
Olena Zimba1,2,3 · Burhan Fatih Kocyigit4 · Esha Kadam5 · Glenn Haugeberg6,7 · Simeon Grazio8,9,10,11 ·
Zofia Guła1,12 · Magdalena Strach1,12 · Mariusz Korkosz1,12

Received: 30 April 2024 / Accepted: 31 May 2024 / Published online: 22 June 2024
© The Author(s) 2024

Abstract
Spondyloarthritis (SpA) is a group of inflammatory disorders, including axial SpA (axSpA), characterized by inflammation
in the spine and sacroiliac joints. Healthcare professionals have a crucial role in diagnosing and managing axSpA. Assess-
ing their knowledge, perceptions, and practices is essential to enhance patient care. The objective of this study is to evalu-
ate these factors by conducting an online survey. This online survey was performed using SurveyMonkey.com to assess
healthcare professionals’ knowledge, perceptions, and practices related to axSpA diagnosis, management, and monitoring.
The questionnaire included questions about definitions, management strategies, monitoring approaches, treatment options,
and barriers to care. Convenience sampling was used, and the data were analyzed descriptively by Microsoft Excel. One
hundred sixty-four healthcare professionals participated; most respondents were rheumatologists from various geographic
locations (27 countries). Most participants were familiar with axSpA definitions and diagnostic criteria, demonstrating
high expertise. Variations were seen in follow-up intervals and diagnostic preferences, reflecting clinical heterogeneity.
Seventy-two (43.9%) individuals had a multidisciplinary team, frequently including rheumatologists, physiotherapists,
and radiologists. Of the participants, 73 (44.5%) had online/telephone follow-up sessions. The pharmacological and non-
pharmacological treatment approaches varied, pointing to the importance of personalized care. Glucocorticoid use varied
among countries. Recognizing inflammatory back pain, interpreting radiographs, and diagnosing early was essential to
medical education. This study provides beneficial data on healthcare professionals’ knowledge, perceptions, and practices
regarding axSpA. While diagnostic familiarity and multidisciplinary approach are positives, there is a potential to stan-
dardize management, improve telemedicine services, remove barriers to physical activity, and optimize treatment options.

Keywords Axial spondyloarthritis · Diagnosis · Exercise · Rehabilitation · Surveys and questionnaires · Treatment

Introduction forms: radiographic axSpA (r-axSpA) and non-radiographic

axSpA (nr-axSpA) [3, 4].
Spondyloarthritis (SpA) is an umbrella term that describes AxSpA has a diverse array of clinical signs. Regretta-
a group of inflammatory diseases with comparable clinical bly, none of the individual attributes obtained from medi-
manifestations and inherited features. Although there can be cal documentation, physical tests, laboratory outcomes,
variations in reported data, the estimated prevalence in the or radiologic screenings possess the precision required to
general population is approximately 1% [1, 2]. The form identify axSpA conclusively. To diagnose axSpA, it is nec-
of this group, termed axial SpA (axSpA), is distinguished essary to define a set of distinct patterns that, when con-
by the prominent involvement of the spine and sacroiliac sidered together, offer sufficient evidence to confirm the
joints. Inflammatory back pain, stiffness, sleep disorders, presence of the disease [5]. Currently, numerous options
and tiredness are characteristic for axSpA. AxSpA has two are available to monitor axSpA. Most of the options depend

Extended author information available on the last page of the article

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1502 Rheumatology International (2024) 44:1501–1508

on laboratory analyses, imaging assessments, and patient- one open-ended question. There were 6 sociodemographic
reported outcomes [6, 7]. The treatment of axSpA involves questions.
a combination of non-pharmacological and pharmacologi- Respondents could modify their responses before submit-
cal interventions. An individualized strategy is of utmost ting them but not after the submission. All questions have
importance. It is crucial to combine non-pharmacological been designated mandatory to ensure that the SurveyMon-
and pharmacological methods to treat axSpA [8, 9]. key platform automatically removes incomplete responses.
Healthcare professionals play a crucial role in diagnos-
ing, managing, and monitoring patients with axSpA [10]. Sampling strategy
Gaining an insight into healthcare professionals’ knowledge,
perceptions, and practices related to the diagnosis, manage- We employed a convenience sampling approach. The sur-
ment, and monitoring of axSpA is essential for enhancing vey link was disseminated on X (Twitter) and Facebook
the quality of care and optimizing outcomes. from April 4 to 23, 2024.
This article presents findings from an online survey to
assess health professionals’ knowledge, perceptions, and Ethics approval
practices related to axSpA. By exploring health profession-
als’ understanding of axSpA diagnostic criteria, treatment The survey’s research protocol was approved by the Insti-
modalities, and monitoring strategies, this study aims to tutional Review Board (IRB) of the Jagiellonian University
identify unmet needs and areas for improvement in clinical Medical College (protocol N 118.6120.07.2023, June 15,
practice. 2023). All participants provided informed consent before
completing the questionnaire, with the assurance that their
responses would be used solely for research purposes.
Methods
Confidentiality, integrity, and availability
This survey aimed to assess healthcare professionals’
knowledge, perceptions, and practices regarding the diagno- The survey used anonymization with Internet Protocol (IP)
sis, management, and monitoring of axSpA patients. It was identities and participant emails as the only identifiable indi-
conducted using SurveyMonkey.com, an internet platform. cators. These indicators played an essential role in ensuring
that each entry was unique to the individual. Data manage-
Survey design ment ensured optimal anonymity as the authors stored IP
addresses and emails only. Subsequently, access to synthe-
The survey questionnaire (Appendix 1) was designed based sized data displayed in tables without recognizable interac-
on an extensive review of current literature and EULAR tion was offered. We adhered to the latest recommendations
practice guidelines [11, 12] to gather information on defini- on designing, planning, and reporting survey studies [13].
tions, management strategies, monitoring approaches, and
practices related to pharmacologic and non-pharmacologic Statistical analysis
treatments in axSpA. The questionnaire also reflected the
views of healthcare professionals on obstacles to patients’ The results section predominantly provided descriptive sta-
physical activities, strategies for reducing cardiovascular tistics. The normality of the distribution of all parameters
risk, the current status of online consultations, and the avail- was checked by the Shapiro-Wilk test. The descriptive sta-
ability of multidisciplinary teams. tistics were reported using the following indicators: num-
Five axSpA experts reviewed the questionnaire over two ber (n), percentage (%), and median (minimum-maximum).
rounds of revisions to correct the questions, refine the word- Microsoft Excel was utilized to generate figures during
ing, and ensure the consistency and validity of the content. the visualization process. Chi-square tests were employed
This was followed by a simulated online form completion to compare responses between groups. The results were
to evaluate the questionnaire in real time. To gather data, ten deemed statistically significant at a P value of less than 0.05.
independent health professionals from different disciplines The statistical analysis was conducted with Microsoft Excel.
were requested to complete the survey. The survey outcomes
were assessed, and feedback was obtained. Following this
procedure, the questionnaire was revised and finalized.
The final version of the questionnaire consisted of 33 ques-
tions, with 9 being multiple-choice, 17 single-answer, and

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Results recommendations for axSpA, with 8 (4.9%) responding ‘not

sure’ and 7 (4.2%) responding ‘no’. A total of 97 (59.1%)
Baseline characteristics of participants respondents reported a special interest in axSpA, and 58
(35.4%) reported being a member of a dedicated axSpA
A total of 164 individuals participated in the survey, with clinic.
a median age of 42 (19–75) years. Out of the total partici-
pants, 85 (51.8%) were female, 75 (45.7%) were male, and Management strategies
4 (2.5%) chose not to disclose their gender. The median
duration following graduation was 17 (1–50) years. There Ninety-nine (60.4%) participants reported assessing axSpA
were participants from 27 countries (Fig. 1). There were patients at 3-month follow-up visits, 54 (32.9%) at 6-month,
129 consultant rheumatologists, 16 residents, 18 physiat- 3 (1.8%) at 9-month, and 8 (4.9%) at 12-month follow-ups.
rists, 2 general practitioners, and 9 individuals from allied A total of 128 (78.1%) participants stated that individuals
professions. A total of 115 individuals were employed at the with axSpA typically seek care from either the general rheu-
university teaching hospital, while 26 were employed at the matology department or the axSpA outpatient clinic when
outpatient center, 23 at the tertiary referral center, 7 were at they experience flares. Meanwhile, 14 (8.5%) participants
the rehabilitation center, and 12 at other facilities. Addition- were unsure, and 22 (13.4%) responded no. When a patient
ally, 27 participants were employed at private practice. with suspected axSpA is first examined, the preferences for
imaging tests for the sacroiliac joints to confirm the diag-
Knowledge about definitions and participant nosis and/or fulfill the ASAS classification criteria were as
experience follows: 92 (56.8%) responders employed both magnetic
resonance imaging (MRI) and X-ray, 20 (13.5%) MRI only,
The National Library of Medicine’s Medical Subject Head- and 50 (30.5%) X-ray only. When X-ray examination of
ings (MeSH) introduced the definition of axSpA in 2022, the sacroiliac joints in patients with suspected axSpA was
and 151(92.1%) respondents were familiar with it. When normal/uninformative, the choices of testing were as fol-
assessing the patients in view of the Assessment in Spon- lows: 39 (23.8%) respondents used both sacroiliac joint
dyloArthritis International Society (ASAS) classification and spinal MRI and 123 (75%) sacroiliac joint MRI only.
criteria for axSpA, 150 (91.5%) respondents used axSpA, Seventy-two (43.9%) participants had a multidisciplinary
nr-axSpA, or r-axSpA diagnostic terms. One hundred and team/clinic managing axSpA patients at their centers. Of
forty-nine (90.9%) respondents were familiar with 2016 the participants working with a multidisciplinary team, 60
and 2022 updates of the ASAS-EULAR management reported that rheumatologists, 31 rheumatology specialist
Fig. 1 Country-wise distribution
of respondents

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nurses, 51 physiotherapists, 12 occupational therapists, 23 strategy by 44, and all the mentioned by 147 participants.
cardiologists, 14 clinical psychologists, and 47 musculo- The number of participants who used the ASAS Health
skeletal radiologists were members of the team. Index (ASAS HI) in their daily examination practice was 36
Out of the all participants, 73 (44.5%) were engaged in (21.9%); 99 (60.4%) did not use it; and 29 (17.7%) had no
online/telephone follow-up consultations to monitor the knowledge of this index.
health and treatment compliance of axSpA patients. The The axSpA patients who should be treated by nonste-
three countries with the highest number of respondents were roidal anti-inflammatory drugs (NSAIDs) were reported as
compared in terms of using online/telephone follow-up con- follows: 133 (81.1%) respondents mentioned about patients
sultations. Although Polish responders frequently relied on with pain and stiffness, 60 (36.6%) - patients tolerating
such consultations, there were no statistically significant low-medium doses of NSAIDs, 119 (72.6%) - symptom-
differences among the three countries (22.2% for Türkiye, atic patients with active inflammation who tolerate maximal
42.9% for Poland, and 21.7% for the Czech Republic; doses, and 101 (61.6%) - patients without NSAIDs side
p = 0.134). The axSpA activity and quality of life measures effects.
used in the assessment process were reported as follows: The glucocorticoid treatment strategies acceptable for
142 (86.6%) participants used Bath Ankylosing Spondylitis the participants were as follows: glucocorticoid injections
Disease Activity Index (BASDAI), 107 (65.2%) Ankylosing at the sites of articular and periarticular/enthesial inflamma-
Spondylitis Disease Activity Score (ASDAS), 78 (47.6%) tion (136 [82.9%] participants), short-term high-dose oral
Bath Ankylosing Spondylitis Functional Index (BASFI), therapy (e.g., 50 mg/day) (22 [13.4%]), long-term low-dose
42 (25.6%) Bath Ankylosing Spondylitis Metrology Index oral therapy (9 [5.5%]), local and/or oral therapy for uve-
(BASMI), 18 (10.9%) Ankylosing Spondylitis Quality of itis (110 [67.1%]), all approaches (7 [4.3%]), and none (5
Life Questionnaire (ASQOL), and 8 (4.9%) Work Produc- [3.1%]) (Fig. 3). The top three countries were selected based
tivity and Activity Impairment Questionnaire (WPAI). In on the number of participants (Türkiye, Poland, and Czech
addition, 16 (9.8%) participants reported using all scales. Republic); steroid use strategies among these three countries
Six (3.7%) participants reported measuring the physical were compared with the Chi-square test. There was no sta-
activity of axSpA patients using accelerometers. Four of tistically significant difference in the use of glucocorticoid
these six participants were consultant rheumatologists, one injections at the sites of articular and periarticular/enthe-
was a physiatrist, and one was a resident. The factors seen sial inflammation, short-term high-dose oral glucocorticoid
as barriers to maintaining the recommended physical activ- therapy, and long-term anti-inflammatory glucocorticoid
ity for patients with axSpA were as follows: high level of oral therapy at low doses (p > 0.05). There was only a sig-
symptoms (pain, fatigue, stiffness) reported by 125 (76.2%) nificant difference between countries in steroid use for the
participants, depression or mood disorders by 88 (53.7%), management of uveitis (p = 0.02) (92.8% for Poland, 69.6%
absence of support from family, friends, and social workers for the Czech Republic, and 50% for Türkiye). The promi-
by 63 (38.4%), and absence of advice from healthcare work- nent countries in terms of the use of short-term high-dose
ers by 60 (36.6%) (Fig. 2). In axSpA, cardiovascular risk oral glucocorticoid therapy were Türkiye (n = 6), Poland
assessment priorities were the following: antihypertensive (n = 4), Ukraine (n = 3), and the Czech Republic (n = 3).
strategy was highlighted by 36, body weight control strat- The prominent countries in terms of the use of long-term
egy by 40, lipid-lowering strategy by 34, smoking cessation

Fig. 2 The main barriers to

maintaining physical activity in
patients with axSpA

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Fig. 3 AxSpA glucocorticoid

treatment strategies acceptable
for the survey participants

Fig. 4 The main scenarios when

biological drugs for axSpA are
preferred the survey respondents

anti-inflammatory glucocorticoid oral therapy at low doses number of participants who discussed the most preferred
were Türkiye (n = 2), Poland (n = 2), and Croatia (n = 2). treatment modalities and best possible management plans
The conventional synthetic disease-modifying antirheu- with their patients with axSpA and/or their caregivers as
matic drugs (csDMARDs) of choice for peripheral manifes- part of a shared decision-making process was 146 (89%).
tations/arthritis of axSpA were methotrexate (103 [62.8%] The number of participants who considered costs incurred
participants), sulfasalazine (143 [87.2%]), and leflunomide when evaluating the cost-effectiveness of imaging/treat-
(29 [17.7%]). ment modalities, particularly biologic/targeted synthetic
The scenarios where biologics such as tumor necrosis drugs, was 126 (76.8%).
factor (TNF)-alpha inhibitors were preferred were as fol- The number of participants who encountered patients
lows: 148 (90.2%) participants pointed to cases when differ- who developed axSpA after recovering from COVID-19
ent NSAIDs and non-pharmacological treatment modalities was 57 (34.8%).
were ineffective, 135 (82.3%) - when axSpA activity mea- An open-ended question was used to identify priorities in
sured by composite measures (e.g. BASDAI, ASDAS) was specialty training for diagnosis and management of patients
persistently high, 26 (15.9%) - when above low disease with axSpA. The following three main themes were men-
activity, and 100 (60.9%) - when fast progression of struc- tioned by the participants: assessment of inflammatory back
tural damage on X-ray. (Fig. 4). pain (n = 40), radiologic examination (n = 37), and early
When TNF-alpha inhibitor therapy failed to suppress diagnosis (n = 28).
inflammation (secondary ineffectiveness, not side effects),
the preferred treatment strategies were as follows: 44
(26.8%) participants reported administering another TNF- Discussion
alpha inhibitor, 64 (39%) - administering anti-IL-17 ther-
apy, 32 (19.5%) - administering a JAK inhibitor, and 91 This survey’s results provide insights into healthcare pro-
(55.5%) reported that all three options were applicable. The fessionals’ knowledge, perceptions, and practices regard-
number of participants who routinely applied non-phar- ing the diagnosis, management, and monitoring of axSpA.
macological treatment modalities was 143 (87.2%). The Gaining a comprehensive understanding of these factors is

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crucial for enhancing the quality of patient care and achiev- patients residing in rural regions or with restricted mobility
ing favorable outcomes in the management of axSpA. [21, 22].
The majority of the survey participants were consultant Barriers to sustaining suggested physical activity for
rheumatologists. The median length of experience fol- axSpA patients were primarily symptom-related, empha-
lowing graduation was seven years. More than half of the sizing the impact of pain, fatigue, and stiffness on physical
participants were employed at the university teaching hos- function and quality of life. Addressing these obstacles with
pital. The countries with the highest number of respondents individualized exercise initiatives, psychological assistance,
were Turkiye (n = 36), Poland (n = 28), and Czech Republic and education may increase compliance with physical activ-
(n = 23). It is anticipated that rheumatologists will mostly ity recommendations and enhance patient outcomes.
participate in a survey related to axSpA, given this is one of The survey yielded valuable information regarding phar-
their primary focus areas [14]. macological treatment approaches for axSpA, encompass-
AxSpA predominantly affects the axial skeleton and sac- ing the utilization of NSAIDs, glucocorticoids, csDMARDs,
roiliac joints. Currently, ASAS-EULAR recommendations and biologic/targeted synthetic DMARDs. NSAIDs were
exist for the management of patients [12, 15]. Most respon- often given for symptom alleviation. Glucocorticoid treat-
dents were acquainted with the definition of axSpA. In ment approaches exhibited variability, with a preference for
addition, many participants demonstrated familiarity with local injections, short-term oral therapies, and long-term
the diagnostic terminology utilized in the ASAS classifica- low-dose therapies. These findings demonstrate the intri-
tion criteria for axSpA. Moreover, a substantial number of cacy of controlling symptoms associated with axSpA and
respondents indicated their acquaintance with the ASAS- emphasize the necessity for personalized treatment strate-
EULAR management recommendations, demonstrating gies [23].
their knowledge of the current standards for managing It was emphasized that biologic drugs, particularly TNF-
axSpA. alpha inhibitors, are preferred for individuals who do not
The survey uncovered variances in the frequency of fol- respond to NSAIDs or have high disease activity. Further-
low-up visits for axSpA patients, with the majority choos- more, the survey looked into the secondary ineffectiveness
ing 3-month intervals. However, there were preferences for of TNF-alpha inhibitors and other treatment options. Partic-
6-month and 12-month follow-ups. This variability may be ipants indicated that a different TNF-alpha inhibitor, IL-17
due to variances in patient populations, disease severity, and inhibitor, and JAK inhibitor would be appropriate.
healthcare system characteristics. Most respondents employed non-pharmacological man-
Imaging of the sacroiliac joints is a crucial component agement approaches, highlighting the need for holistic
for evaluating axSpA [16]. Participants preferred both MRI approaches to axSpA care. Decision-making collaboratively
and X-ray investigations when diagnosing axSpA. How- and cost-effectiveness considerations in assessing treat-
ever, there was also a broad adoption of MRI or X-ray ments were also frequently reported, indicating patient-
alone. Diagnostic approaches differ, affecting the diagnostic focused and value-based concepts.
accuracy and patient outcomes. Standardized protocols or Similarities emerged when the top three countries’ gluco-
guidelines can help to expedite diagnostic paths and opti- corticoid use strategies were compared. However, there was
mize resource utilization [17, 18]. a difference in uveitis management approaches. It highlights
Approximately half of the participants reported engaging the possible impact of geographical characteristics such as
multidisciplinary teams in managing axSpA. This highlights health systems, cultural practices, and resource availability
the acknowledgment of the intricate nature of axSpA and on treatment decisions and outcomes.
the requirement for comprehensive care. Rheumatologists The open-ended question unveiled critical areas of focus
were the most commonly reported members of multidisci- for medical specialty training in axSpA, encompassing
plinary teams, followed by physiotherapists and musculo- the evaluation of inflammatory back pain, radiographic
skeletal radiologists. This interdisciplinary approach aligns analysis, and early diagnosis. By addressing these training
with current recommendations and allows comprehensive gaps, healthcare providers can improve their proficiency in
care customized to meet each patient’s specific needs [19, detecting and managing axSpA, leading to better patient
20]. outcomes.
Nearly 50% of participants reported utilizing online/
phone follow-up consultations to monitor axSpA patients.
This indicates the potential for extending telemedicine
services in the management of axSpA. Telemedicine has
an opportunity for remote monitoring, prompt interven-
tion, and improved healthcare accessibility, particularly for

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2. Stolwijk C, Boonen A, van Tubergen A, Reveille JD (2012)

Conclusion Epidemiology of spondyloarthritis. Rheum Dis Clin North Am
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This study offers helpful information about healthcare pro- 3. Hay CA, Packham J, Prior JA, Mallen CD, Ryan S (2024) Barri-
fessionals’ knowledge, perceptions, and practices regarding ers and facilitators in diagnosing axial spondyloarthritis: a quali-
tative study. Rheumatol Int 44:863–884. https://doi.org/10.1007/
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plinary care have advanced, there are also unmet needs in 4. Kishimoto M, Ono K, Fukui S et al (2021) Clinical character-
standardizing management approaches, enhancing telemed- istics of non-radiographic versus radiographic axial spondylo-
icine services, overcoming obstacles to physical activity, arthritis in Asia and non-radiographic axial spondyloarthritis
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and optimizing pharmacological and non-pharmacological SPA study. RMD Open 7:e001752. https://doi.org/10.1136/
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MS, MK. Writing – review and editing: OZ, ZG, MS, MK. Final ap- org/10.1038/s41584-022-00761-z
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Funding This work has been supported by a grant entitled ‘The POL- of the ASAS/EULAR recommendations for the management of
ish NORwegian research collaboration to increase quality of health axial spondyloarthritis. Ann Rheum Dis 82:142–152. https://doi.
care and improve health outcomes of children and adult patients with org/10.1136/ard-2022-223297
RHEUMAtological diseases’ (POLNOR-RHEUMA) 0026/2019-00 10. Gudu T, Jadon DR (2020) Multidisciplinary working in the man-
from the National Center for Research and Development (NCBiR).” agement of axial and peripheral spondyloarthritis. Ther Adv Mus-
and “Support program for Ukrainian researchers” (POLNOR-RHEU- culoskelet Dis 12:1759720X20975888. https://doi.org/10.1177/1
MA ‘UA’) FWD/II/118/POLNOR-RHEUMA_UA/2022 from the Na- 759720X20975888
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Declarations org/10.1136/annrheumdis-2016-210770
12. Ramiro S, Nikiphorou E, Sepriano A et al (2023) ASAS-EULAR
Conflict of interest None declared recommendations for the management of axial spondyloarthritis:
2022 update. Ann Rheum Dis 82:19–34. https://doi.org/10.1136/
Open Access This article is licensed under a Creative Commons ard-2022-223296
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if changes were made. The images or other third party material in this (2021) Which Magnetic Resonance Imaging Lesions in the sacro-
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holder. To view a copy of this licence, visit http://creativecommons. advances in diagnosis and management. BMJ 372:m4447. https://
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Authors and Affiliations

Olena Zimba1,2,3 · Burhan Fatih Kocyigit4 · Esha Kadam5 · Glenn Haugeberg6,7 · Simeon Grazio8,9,10,11 ·
Zofia Guła1,12 · Magdalena Strach1,12 · Mariusz Korkosz1,12

4
Olena Zimba Department of Physical Medicine and Rehabilitation,
[email protected] University of Health Sciences, Adana City Research and
Training Hospital, Adana, Türkiye
Burhan Fatih Kocyigit
5
[email protected] Seth Gordhandhas Sunderdas Medical College and King
Edwards Memorial Hospital, Mumbai, Maharashtra, India
Esha Kadam
6
[email protected] Division of Rheumatology, Department of Internal Medicine,
Sørlandet Hospital, Kristiansand, Norway
Glenn Haugeberg
7
[email protected] Department of Neuromedicine and Movement Science,
Faculty of Medicine and Health Sciences, NTNU, Norwegian
Simeon Grazio
University of Science and Technology, Trondheim, Norway
[email protected]
8
Sestre milosrdnice University Hospital Centre, Zagreb,
Zofia Guła
Croatia
[email protected]
9
Department of Rheumatology, Physical and Rehabilitation
Magdalena Strach
Medicine, School of Medicine, University of Zagreb, Zagreb,
[email protected]
Croatia
Mariusz Korkosz 10
Referral Centre for Spondyloarthritides, Ministry of Health
[email protected]
of Republic of Croatia, Zagreb, Croatia
1 11
Department of Rheumatology, Immunology and Internal UEMS PRM Board Training Centre in Physical and
Medicine, University Hospital in Kraków, Kraków, Poland Rehabilitation Medicine, Zagreb, Croatia
2 12
National Institute of Geriatrics, Rheumatology and Department of Rheumatology and Immunology, Jagiellonian
Rehabilitation, Warsaw, Poland University Medical College, Kraków, Poland
3
Department of Internal Medicine N2, Danylo Halytsky Lviv
National Medical University, Lviv, Ukraine

13